Customer Credit Application

JUSTIN COULTER
Director of Sales
502.552.1683‬
[email protected]

Business Name

Primary Contact Name

First Last

Email(Required)

Email me when the shocks are for sale.

Phone

Estimated Order Quantity(Required)

Please enter a number greater than or equal to 1.

Your Business Relationship Manager(Required)

Name

First Last

Email(Required)

Email me when the shocks are for sale.

Text/SMS

Please also send me an SMS text message

"*" indicates required fields

Step 1 of 4

Your Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

JUSTIN TEVIS
Director of Finance
805.696.5521
[email protected]

Name(Required)

First Last

Company Name(Required)

Position with Company(Required)

Email(Required)

GERRY LAMBERTI
Chairman & CEO
805.453.2726
[email protected]

TOM BATEMAN
Director of Marketing
208.512.0855
[email protected]

JENI CHEN
Director of Operations
805.698.1608
[email protected]

ADAM WEISNER
President
208.449.9506
[email protected]

Thank you for leaving a review for the . We’re excited to be part of making your journey better.

Name*
First Last
Company Name
Title
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone

Please provide company information, bank reference information, and four trade references.

Step 1 of 6

Company Information
Company Name*
Doing Business As (DBA)
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Contact*
First Last
Phone
Email
Primary Contact Position/Title*
Shipping Address
If different from Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Business*
- Proprietorship
- Partnership
- Corporation
Federal Tax Payer ID No.
Year Business Established*
Please enter a number from 0000 to 9999.
Resale No.
Attachments
Without a copy of your Tax Exemption Certificate your Customer Credit Application cannot be processed. You must attach a copy to continue with this form. Please attach below as a jpg, pdf, tif, png, or similar file type.
Tax Exemption Certificate
Maximum file(s) size = 20MB.
Accepted file types: jpg, txt, gif, png, pdf, tif, ai, psd, zip, eps, doc, docx, Max. file size: 20 MB.
Do you have a Resale Certificate for your state?*
- Yes
- No
- Not applicable
Resale Certificate*
Please follow all rules according to your state when submitting valid Resale Certificates. Maximum file(s) size = 20MB.
Accepted file types: jpg, txt, gif, png, pdf, tif, ai, psd, zip, eps, doc, docx, Max. file size: 20 MB.

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Bank Reference
Bank Name*
Account No.*
Bank Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank Contact
First Last
Bank Phone*
Bank Fax*

Save and Continue Later

Trade Reference #1
Reference #1 Company Name*
Reference #1 Phone*
Reference #1 Email*
Reference #1 Fax
Reference #1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Save and Continue Later

Trade Reference #2
Reference #2 Company Name*
Reference #2 Phone*
Reference #2 Email*
Reference #2 Fax
Reference #2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Save and Continue Later

Trade Reference #3
Reference #3 Company Name*
Reference #3 Phone*
Reference #3 Email*
Reference #3 Fax
Reference #3 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Save and Continue Later

Trade Reference #4
Reference #4 Company Name*
Reference #4 Phone*
Reference #4 Email*
Reference #4 Fax
Reference #4 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Save and Continue Later

Credit Reference

Credit Referral
Please complete this form so we may determine the credit worthiness of this applicant.
Your Company Information
Company Name:*
Name*
First Middle Last
Referral information
Sold Since:
High Credit:
Date of Last Sale:

Example: 01/01/2019
A/R Balance:
A/R Info:
Current